Jails and prisons have become the United States’ largest housing complex and healthcare system for people with mental health and substance abuse issues. As former Albany Police Chief Brendan Cox told the College Hill Independent, “it’s not working.”
Cox, now director of policing strategies for the Law Enforcement Assisted Diversion (LEAD) program, is building new solutions. LEAD is a pre-arrest program that interrupts the revolving-door cycle of incarceration (about half of people released from jail or prison will return within three years, according to the Pew Center on the States) by helping people access stable housing and behavioral health services. When a LEAD-trained police officer arrests someone on an eligible charge, the officer can offer the individual enrollment in the program instead of putting them in jail. If the person opts in, they will be matched with a case manager and referred to services, such as mental health and substance abuse treatment, avoiding the criminal legal system altogether.
Cox summarized LEAD neatly: “Police have to stop being everybody’s answer to public health issues. Law enforcement can’t solve homelessness.”
Now, local advocates want to bring LEAD to Rhode Island. Diego Arene-Morley, the community engagement coordinator at Rhode Island Communities for Addiction Recovery Efforts (RICARES), is working to bring the program to Pawtucket, as a response to the opioid crisis. (Central Falls, Providence, and Pawtucket have higher overdose rates than the rest of the state.)
When I met with Arene-Morley, he wore a bright yellow long-sleeve t-shirt, high-top red Converse sneakers, and translucent red-framed glasses. His informality mirrored the room we sat in on the third floor of the Mathewson Street United Methodist Church in downtown Providence, open with high ceilings, tall windows, and various pamphlets about behavioral health services stuffed among books and binders.
Displayed on the mantel was Arene-Morley’s peer recovery specialist certificate, announcing that he uses his lived experience recovering from substance abuse and mental health issues, plus formal skills learned in training, to provide peers with recovery services. He believes LEAD in Pawtucket will demand much-needed public health responses—rather than stigmatization and criminalization—for folks with substance abuse and mental health issues. As other cities across the country have shown, LEAD can be a catalyst for changing our punitive culture, for moving away from arrest as a first response, and for providing people with the resources they need.
LEAD was launched in Seattle in 2011 to address racial disparities in drug policing, reduce recidivism rates, and respond to the opioid epidemic.
Several years earlier, civil right advocates at the Racial Disparity Project had threatened to sue the Seattle Police Department for discriminating against people of color. Frustrated, the department replied that their only option for responding to illegal drug users was incarceration. So, in an unprecedented collaboration between police, prosecutors, civil rights advocates, public defenders, political leaders, and service providers, people from across Seattle worked together to build another option: a community-based diversion program that places people in trauma-informed care systems—LEAD.
For many activists, police are the symbol of a racist and violent system, which makes their involvement in police reform efforts controversial. For LEAD advocates, however, police are a starting point in the process of moving public health issues away from the criminal legal system.
LEAD is premised on the philosophies of “housing first” and “harm reduction.” Housing first acknowledges that people need a stable place to live before they can address less critical (yet still important) issues in their lives, such as getting a job or overcoming substance abuse. Harm reduction means focusing on individual and community wellness, instead of demanding sobriety from drug users. Participants are encouraged, but not rushed or required, to work toward treatment. Both of these philosophies are unusual in a system that forces people to earn basic resources through compliance (i.e. sobriety), rather than understanding social services as human rights.
Participants enter Seattle’s LEAD program through one of two avenues: upon arrest or by “social contact referral.” The first option means when police officers arrest an individual on a LEAD-eligible charge (in Seattle, low-level offenses such as drug possession and sales, or sex work), the officers may decide to offer the individual enrollment in the LEAD program. Cox admitted to the Indy that it often takes stakeholders, especially law enforcement, time to embrace LEAD—understanding mental health and substance abuse issues as public health problems rather than crimes, and thus referring participants to case management instead of relying on arrests.
Social contact referrals can catch people before they enter the web of the criminal legal system. This option allows other stakeholders—public defenders, prosecutors, or case managers, for example—to suggest people be offered LEAD services.
Both methods completely divert people away from the legal system and toward the resources that address unmet needs for services that address substance abuse, mental illness, homelessness, and poverty.
The program also prevents future legal involvement. In 2015, a series of independent evaluations conducted by researchers at the University of Washington found LEAD reduced recidivism. LEAD participants were 58 percent less likely to be re-arrested after enrollment in the program, compared to a control group that went through system-as-usual legal processing. The findings also indicated improvements for LEAD participants across housing and employment outcomes.
LEAD functions as both a public safety and public health program. It improves the well-being of people struggling at the intersection of poverty, mental health, and substance abuse issues—which over half the national incarcerated population does, according to the Prison Policy Initiative. As of September 2018, LEAD in Seattle had reached 525 people.
After LEAD’s success in Seattle, other cities followed suit. Santa Fe, New Mexico, and Albany, New York, were the next jurisdictions to launch certified programs. So many municipalities called Seattle asking for advice that the LEAD founders established a national organization to assist in implementing the program across the country. The LEAD National Support Bureau’s website now features a map of programs dotting the entire country, including New Orleans under the “operating” column and, closer to home, Pawtucket under “exploring.”
In 2005, Hurricane Katrina disproportionately devastated New Orleans’ poor communities of color, plowing straight through the city’s social support systems. The storm laid bare deeper failures of these systems, rooted in centuries of inequality and vulnerability, and left the jail overpopulated, the healthcare system overloaded and underfunded, and public housing all but demolished. Katrina was not the first time the city, or the country, abandoned these communities.
For a lot of activists, myself included, this tragedy clarified that criminal justice reform needs to embrace holistic solutions to mass incarceration. The importance of access to resources like housing and healthcare inspired my urban studies thesis on LEAD in New Orleans.
In 2013, New Orleans’ Health Department launched the Community Alternatives Program (CAP), a pre-trial diversion program for low-level, nonviolent charges to help defendants in Municipal Court with mental illness receive treatment and support. Officials at the health department realized, however, that CAP only reached individuals already caught up in the cycle of incarceration. They suggested implementing pre-arrest diversion, and in a collaboration with potential stakeholders—the police department, the mayor’s criminal justice council, and the Vera Institute—spent the next two and a half years developing New Orleans’ LEAD program.
LEAD’s expansive scope requires a level of coordination rarely seen in reform programs. Police, prosecutors, government officials, and social service providers have to be willing to come to the table together in order to address structural inequities. In New Orleans, these stakeholders identified the 8th District as the initial LEAD site, since the program was deemed too resource-intensive to start citywide. The 8th District (the French Quarter and Central Business District) had the highest concentration of LEAD-eligible offenses and a rate of arrest per resident at least twice as high as any other district.
It also helped that 8th District Police Commander Nicholas Gernon believes that jail is not the answer to addiction and understands that relapse is a part of recovery. Gernon is committed to LEAD for the long-term: “It’s an investment in people,” he told me. (I interviewed Gernon while researching my thesis.)
Having a progressive officer in charge of the district is significant. Evaluations of Seattle’s LEAD program advise that one of the most difficult elements of building the program’s coalition is line officer buy-in, which Gernon now oversees.
Another obstacle is prosecutor buy-in. Seattle’s success came partly because the district attorney there was enthusiastic about LEAD and involved in its implementation. But in New Orleans, District Attorney Leon Cannizzaro is notoriously pro-incarceration and has refused several offers to collaborate officially on LEAD.
As recently as last month, Cannizzaro called over-incarceration a “myth” and incarceration-reduction methods a threat to public safety “espoused by sheltered academics and naive politicians,” according to the New Orleans Advocate. Since DA’s offices deal with felony cases in New Orleans, LEAD’s only eligible drug-related offense is the misdemeanor of simple possession of marijuana not with intent to distribute. (New Orleans’ District Attorney elections are upcoming in November 2019, so the city will have an opportunity to choose a candidate committed to decarceration programs.)
The LEAD pilot program launched in November 2017, and Gernon has guaranteed funding for a two-year trial period to prove success. As of March 12, 2019, New Orleans’ pilot program had 23 participants, the majority of whom have been housed and entered into behavioral health treatment. While this number may seem small, as a first step, it constitutes a huge victory. Twenty-three people are accessing the resources they need instead of being funneled into incarceration. One “frequent flyer” who used to get arrested, on average, once every three days is now only arrested once or twice a month, and he has moved into subsidized housing. Gernon’s goal is to have 60 program participants by the end of 2019.
Then, the two-year pilot program will end, and LEAD stakeholders will ask the city council to renew funding and expand the program to other districts. Gernon told me that the city council is supportive, and that the police department has undergone a post-Katrina culture shift, acknowledging the importance of alternative-to-incarceration opportunities. Given this support, it seems likely LEAD will be renewed in the 8th District and spread to adjacent districts too.
The opioid crisis hit New England hard. In 2017, Rhode Island recorded 1,673 drug overdoses, 323 of which were fatal—nearly one overdose death every day of the year. According to the Rhode Island Department of Health, overdose deaths increased by almost 90 percent between 2011 and 2017. Deaths related to fentanyl, a highly potent opioid, have increased 15-fold in the last ten years.
All thirty-nine cities and towns in Rhode Island have local nonprofit substance abuse prevention coalitions, which are members of broader regional organizations. RICARES is part of the Pawtucket Prevention Coalition, directed by Diane Dufresne, and is spearheading efforts to create a LEAD program in the city.
Arene-Morley’s plan involves a three-month pilot of LEAD, with a twist: instead of professional case management, Pawtucket would use peer recovery specialists, like himself.
The national LEAD organization approved this proposal, and Arene-Morley used a community overdose grant to bring Cox, the former Albany Police Chief and current LEAD national director of policing strategies, to Pawtucket for a presentation on LEAD’s strategies. In September 2018, Cox presented to stakeholders, including representatives from the Pawtucket Police Department, Mayor’s Office, and Rhode Island Office of the Attorney General.
Cox said his goal for the visit was to explain the core principles of LEAD as well as its origins. In his presentation, he explained that LEAD was not created solely to tackle the opioid epidemic; it was built to address racial disparities in the criminal legal system that disproportionately harm communities of color.
Cox facilitates open discussions with front-line officers about why they’re implementing the LEAD strategy: the system of mass incarceration has failed individuals who commit crimes, has failed the general public which is promised safety, and has failed police officers who strive to provide that safety. LEAD is a public safety tool, he says. “Arrest plus prosecution plus incarceration does not always equal public safety.”
LEAD-eligible people don’t need to be put in jail, Cox argues. Instead, these cases demand addressing the root causes of substance abuse, mental illness, poverty, and homelessness.
Even though the system isn’t working, many officials have a hard time changing their ways. LEAD’s strategy can be counter-intuitive to people who have been trained to rely on arrests and incarceration. In Pawtucket, stakeholders have reached a political stalemate. The mayor’s office and police department are concerned with legal issues surrounding not arresting people who commit certain crimes, said Arene-Morley.
Both the mayor’s office and the police department did not respond to request for comment. Kristy dosReis, a spokesperson for the Rhode Island Attorney General’s Office wrote in an email that “One of AG Neronha’s priorities at the start of his administration has been to explore the office’s ability to elevate and expand access to diversion in Rhode Island.” Asked specifically about obstacles to LEAD’s implementation in Pawtucket, she wrote, “We have not been contacted by Pawtucket officials with concerns.”
In Seattle, the legislature granted the Police Department discretionary authority to decide not to arrest someone for a LEAD-eligible crime and to instead enroll them in the program. In Pawtucket, Arene-Morley says political entities are concerned the proposed program falls outside the legal parameters of law enforcement. However, according to LEAD’s National Support Bureau, 40 other municipalities across the country are successfully implementing it.
Rhode Island, where state and local politics are closely intertwined, is turning instead to the state-police-run Heroin-Opioid Prevention Effort (HOPE). The HOPE initiative focuses on patients discharged from the hospital after suffering an overdose, and incarcerated people, soon to be released, who receive substance abuse treatment in prison. HOPE and LEAD rely on fundamentally different models: the former is retroactive because it waits for people to overdose, whereas the latter is proactive in addressing root causes of crime.
Rhode Island’s recidivism rate, measured three years after release, hovers around 50 percent. LEAD might be able to help, given that the program is proven to reduce recidivism, break the cycle of incarceration, and provide long-term treatment for substance abuse.
Arene-Morley told the Indy that LEAD’s proposed peer-to-peer element in Pawtucket would ensure participants’ recovery contact is outside law enforcement. The community overdose grant would fund peer recovery specialist involvement in LEAD. Arene-Morley says that LEAD is supposed to make police officers’ lives easier by dealing with public health issues that shouldn’t be the responsibility of law enforcement in the first place.
As it stands, Arene-Morley is using the LEAD philosophy to move forward with a pilot effort, which will not be officially LEAD-designated because all of the stakeholders have not signed on. He still plans to conduct targeted peer outreach on behalf of RICARES, similar to LEAD’s social contact referral method.
For him, the next steps include identifying hotspots for drug crime, shoplifting, and sex work. There is a direct correlation between the density of drug crimes and the density of overdoses, so Arene-Morley hopes to find those geographic locations to connect with people interested in using more safely and exploring wellness steps. As a peer recovery specialist, he’ll talk with participants and accompany them in whatever activities they need—getting coffee, setting up a dentist appointment, accessing treatment (there is a 24/7 behavioral health treatment clinic in East Providence). Arene-Morley hopes these efforts will demonstrate the success of a proactive model.
Despite the current setbacks, Arene-Morley has “100 percent hope” for a future of LEAD in Pawtucket. He acknowledges that his organization tried to introduce, develop, and implement the program in less than two years, which is a rapid timeline. Since LEAD relies on a collaborative effort, RICARES now needs to take the time to make sure all stakeholders are on-board.
Cox says it is not unusual to encounter pushback. As he told the Indy, one of the reasons the National Support Bureau makes implementing LEAD a collaborative approach is so the agencies involved feel they have made the decision together, which prevents divisions from threatening the program in the long-term. In Pawtucket, the National Support Bureau will continue to provide peer-to-peer guidance so that all the partners can feel comfortable pursuing LEAD.
It is important to note that while LEAD currently relies on police discretion for enrolling participants, the ultimate reform goal is for substance abuse and mental health treatment to exist entirely outside the realm of law enforcement. To that end, it is critical that LEAD involves pre-arrest diversion, so it can work to eliminate the root causes of crime before people are ever caught up in the revolving-door cycle of incarceration. Effective criminal justice reform requires holistic public health responses, and resources invested in people and communities instead of in police and prisons.
LEAD is not an end-all solution to the racism, violence, and inequity embedded in the criminal legal system, but it is a first step toward rehabilitative, rather than punitive, justice. LEAD’s strength lies in its acknowledgment that the program deals with real human beings with dynamic lives, and recovery is not linear.
As program advocates like to say, LEAD is about meeting people where they’re at but not leaving them there.
RACHEL ROOD-OJALVO B’19.5 knows this article is the closest you’ll get to reading her 100-page urban studies thesis about LEAD in New Orleans.